The topic of hypertension was discussed at the 65th Annual Conference of the Cardiological Society of India (CSI), and featured a collaborative program with the European Society of Cardiology (ESC).

“Hypertension is the most prevalent cardiovascular risk factor among Indian adults. Epidemiological studies have reported that the prevalence of hypertension is 25-35 percent in urban areas and 15-20 percent in rural areas. This is more than the prevalence of hypercholesterolemia, metabolic syndrome or diabetes,” said hypertension expert, Dr. Rajeev Gupta from India.

In India, hypertension accounts for 24 percent of deaths from coronary heart disease and 57 percent of stroke deaths.

“As the second-most populous country in the world with over 1.2 billion inhabitants, India’s hypertension burden presents a major public health challenge. Indeed, India and China account for more cases of cardiovascular disease than all developed countries combined,” said Dr. Gupta.

Large regional variations and urban/rural differences exist in the prevalence of hypertension. People who live in urban areas are at the highest risk, and particularly the urban middle-class. Small studies in poor urban areas have also reported a high prevalence of hypertension. Urbanization has dramatically increased levels of hypertension in India, and rural-to-urban migrants are at especially high risk.

“The key lifestyle factors that promote hypertension are sedentary habits and diet. When people migrate from rural areas to urban areas they increase their weight, measured as body mass index (BMI), and they increase their waist size. This is clearly due to changing lifestyles – they become more sedentary and their diet changes. They tend to eat more fat, saturated fat, trans fatty acids and salt, and less fruits and vegetables,” said Dr. Gupta.

“Stress levels are high in migrants and may have an impact, but large studies are needed to confirm the effect of stress on blood pressure in this group. The use of smokeless tobacco, often a mixture of the betel nut, betel leaf and tobacco leaf, may also be a unique risk factor for hypertension in Indians.”

Sedentary lifestyles in urban India are fostered by the lack of spaces for physical activity.

“Cities are not built to support physical activity. In addition, people in urban areas don’t find time to exercise. Another contributing factor is that while many gyms have opened in India, they are very, very expensive and not everyone can afford them. Finally, there are very few public transport systems in the country that run well so people tend to live close to their place of work, which means they don’t walk much,” said Dr. Gupta.

“Multiple strategies are needed to tackle India’s hypertension problem. These include creating awareness (in India just one-third of people with high blood pressure know they have it), providing better treatment in primary and secondary care, and promoting heart healthy lifestyles,” he said.

Dr. Gupta discussed the latest advances in hypertension management to prevent coronary artery disease (CAD) at a special session on CAD prevention during the CSI Annual Conference. Session one focused on treatment of hypertension including medications, non-pharmacological treatment, and therapies for hypertension that is resistant to drug treatment. Session two covered practical issues such as setting blood pressure treatment targets.

“Hypertension is the most common cardiovascular risk factor in India but many people don’t know they have it and it’s often not treated properly. This is a huge problem in a country as populated as India and prevention efforts are essential,” said Professor Krishnan Venugopal, president of CSI.

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Source: Cardiological Society of India; Photo: jasleen_kaur/Flickr/CC.
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